Journal of Marital and Family Therapy doi: 10.1111/j.1752-0606.2012.00287.x April 2013, Vol. 39, No. 2, 148–162 FORGIVENESS AND RECONCILIATION IN EMOTIONALLY FOCUSED THERAPY FOR COUPLES: THE CLIENT CHANGE PROCESS AND THERAPIST INTERVENTIONS Dino Zuccarini Centre for Interpersonal Relationships, University of Ottawa Susan M. Johnson Ottawa Couple and Family Institute, University of Ottawa Tracy L. Dalgleish University of Ottawa Judy A. Makinen Royal Ottawa Mental Health Centre, Ottawa Couple and Family Institute This article presents psychotherapy process research findings related to the forgiveness and reconciliation model, known as the Attachment Injury Resolution Model (AIRM), within the context of emotionally focused therapy for couples (EFT). Outcomes for EFT as an intervention for general relationship distress and AIRM have been successfully tested. Audiotapes of nine resolved and nine nonresolved EFT couple cases were used to study the client change process, the validity of AIRM, and EFT interventions used at each stage of the model. Study findings suggest resolved couple clients engaged deeply with their internal experience were more deliberate and controlled in their processing and more affiliative in their interpersonal responses in comparison with nonresolved couples. Resolved versus nonresolved client in-session performances were discriminated on the basis of four model components. These were associated with significant shifts from secondary reactive emotions to primary attachment–related emotional processing of the injurious incident and with interactions that focus on shaping emotional responsiveness. Key EFT interventions employed in successful attachment injury resolution are also identified. Interpersonal injuries leave long-lasting emotional wounds that indelibly mark couple rela- tionships. In recent years, several forgiveness-specific clinical models have emerged to address such injuries in couples (Baucom, Snyder, & Gordon, 2009; Coleman, 1998; DiBlasio, 1998; Hargrave & Sells, 1997; Johnson, Makinen, & Millikin, 2001). Some of these models have been empirically investigated in outcome studies (DiBlasio & Benda, 2008; Gordon, Baucom, & Snyder, 2004; Makinen & Johnson, 2006). However, questions about how couple clients change in therapy as they move toward forgiveness and what type of interventions facilitate such change remain unexplored. The Attachment Injury Resolution Model (AIRM) has demonstrated that it successfully alleviates relationship distress and promotes forgiveness in injured couples (Makinen & Johnson, 2006). However, research into the client change process and interventions that promote forgiveness upon implementation of the AIRM within emotionally focused therapy (EFT) has yet to be conducted. Process research is of increasing interest to couple therapy researchers as it deepens knowledge about how clients change as a result of treatment (Pinsof Dino Zuccarini, PhD, C Psych, Centre for Interpersonal Relationships, University of Ottawa; Susan M. Johnson, EdD, C Psych, Ottawa Couple and Family Institute, University of Ottawa; Tracy L. Dalgleish, BA, University of Ottawa; Judy A. Makinen, PhD, C Psych, Royal Ottawa Mental Health Centre, Ottawa Couple and Family Institute. Address correspondence to Susan M. Johnson, Ottawa Couple and Family Institute, School of Psychology, University of Ottawa, Ottawa, Ontario; E-mail: [email protected] 148 JOURNAL OF MARITAL AND FAMILY THERAPY April 2013 & Wynne, 2000). Clinical model development based on process research that specifies a resolution path for client problems and effective interventions is most relevant to clinicians (Johnson & Lebow, 2000). Such research bridges the gap between theory, research, and clinical practice in the field of couple therapy (Johnson, 2003). Process research of AIRM supports clinicians in their work of promoting forgiveness and reconciliation in couples beleaguered by emotional injuries. The goals of this psychotherapy process study are to investigate the client change process underlying AIRM, validate the AIRM model, and identify EFT interventions associated with the successful resolution of an injury. EFT FOR COUPLES: CLIENT CHANGE PROCESS AND INTERVENTIONS Emotionally focused therapy for couples is an empirically validated therapy (Johnson, Hunsley, Greenberg, & Schindler, 1999) that places emotion at the clinical forefront as both the target and primary mechanism of client change. Emotion primes perceptions, colors mean- ings and views of self and other, raises awareness of self and attachment needs, and organizes action tendencies in close relationships. Important shifts in emotional processing from second- ary to primary attachment–related emotion are required to precipitate client change. Secondary emotional responses are reactive, self-protective responses, such as anger in response to a part- ner’s perceived inaccessibility. Accessing and integrating primary attachment–related emotions and needs that underlie secondary expressions are viewed as adaptive in close relationships. These expressions are the basis of coherent attachment signals to an attachment figure. For example, the emotional signal of sadness provides an important internal and outward cue about a need for a soothing response from a partner. Systems and attachment theories are used to understand how secondary emotion responses contribute to maladaptive relationship patterns and attachment insecurity (Johnson, 2004). Sec- ondary emotional responses (e.g., angry-blaming, numbing–withdrawal) fuel negative rigid interaction cycles, such as demand–withdraw. These responses and interactions are mutually reinforcing and block partners from more positive emotional engagement. Disparate emotion regulation strategies underlie each partner’s position in the couple’s cycle. Anxiously attached partners typically pursue their partners with heightened emotional expressions to solicit atten- tion, contact, and comfort. Avoidantly attached partners minimize emotional experience to diminish conflict and thus withdraw to maintain a semblance of attachment. These responses block awareness of more primary emotions and needs. Client change occurs in three stages. In stage I of EFT, cycle de-escalation, secondary emo- tional reactions are placed in the context of the cycle and are identified as promoting emotional disconnection. Stage II consists of two critical change events, the withdrawer re-engagement and the blamer softening. These change events mark a shift in partners’ emotional processing as disowned primary attachment–related emotions and needs are accessed and integrated. In the blamer-softening event, the pursuing partner discloses soft primary emotions, such as fear of abandonment and rejection, and asks for care and support. His or her partner’s new ability to respond with care and compassion is often an antidote to rigid, negative interaction cycles and shapes a positive cycle of reaching and caring responsiveness. In stage III, couples consoli- date and integrate their new positions and new cycles of positive attachment behavior. In EFT, experiential and systemic interventions are used to facilitate the client change pro- cess. Experiential interventions (e.g., empathic reflections ⁄ attunement, validation, evocative responding), heightening, and empathic conjectures are used to facilitate access to, exploration and expansion of attachment-related emotions and needs. Systemic interventions (e.g., tracking and reflecting process, reframing partners’ experiences ⁄ interactions in terms of the negative cycle) and enactments are used to restructure negative interaction cycles and facilitate new cycles of emo- tional engagement that foster more secure emotional bonding. In a recent analysis of the blamer- softening event, EFT interventions used included evocative responding, heightening, validation, empathic conjecture ⁄ interpretation, reframing, and restructuring interactions (Bradley & Furrow, 2004). Experientially oriented interventions support the pursuer to access and express vulnerabil- ity and withdrawers to emotionally re-engage, while systemic-oriented interventions facilitate the creation of new enactments characterized by increased mutual accessibility and responsiveness. April 2013 JOURNAL OF MARITAL AND FAMILY THERAPY 149 MEASUREMENT OF CLIENT CHANGE IN EFT RESEARCH Process measures are used to examine critical shifts in client’s manner of engagement that contributes to successful outcome. In EFT, primary emotions are accessed, explored, and expanded to facilitate client shifts toward more adaptive integrated emotion and need expres- sion in relationships. This involves greater experiential involvement in therapy as clients focus inward on their meaning-making process. Client experiential involvement in EFT has been assessed using the Experiencing Scale (ES; Klein, Mathieu-Coughlan, & Kiesler, 1986). As a cli- ent’s level of experiential involvement deepens, the client’s discourse shifts from superficial and impersonal to more internal self-referenced statements. Deeper levels of engagement have been associated with positive and successful therapy outcomes in EFT for couples (Johnson & Greenberg, 1988; Makinen & Johnson, 2006). A client’s manner of processing and articulating primary emotional experience may also be critical to the client change process. The Levels of Client Perceptual Processing (LCPP; Touk- manian & Gordon, 2004) classifies client discourse from automatic, rigid, and undifferentiated to more flexible, differentiated, reflective, and integrative modes